Physician Coding Auditor

Medkoder, LLC; United States; Remote; USD 75,000 - 100,000; Full time

Job summary

Medkoder, LLC is seeking a full-time Physician Coding Auditor to join their remote team. The ideal candidate will have extensive experience in healthcare coding, specifically in auditing, and be responsible for ensuring compliance with various coding guidelines. This role offers competitive benefits, including employer-paid health insurance and a supportive atmosphere for professional development.

Benefits

Generous paid time off

Employer-paid medical, dental, and vision benefits

401K and Profit Sharing

Paid AAPC and AHIMA corporate memberships

30 Hours of CEU pay

Qualifications

• Minimum 5 years of recent physician coding experience and 3 years of recent physician auditing experience required.
• Successful completion of at least one AHIMA or AAPC certified program.
• Must have expert knowledge of medical terminology, anatomy and coding guidelines.

Responsibilities

• Perform professional compliance audits of coding and documentation for multiple specialties.
• Accurate selection and application of ICD and CPT coding guidelines.
• Prepare and present audit follow-up education to clients.

Skills

Attention to Detail

Communication

Time Management

Analytical Thinking

Problem Solving

Education

High School diploma

Associate or BS degree

Certified Professional Medical Auditor (CPMA)

Certified Professional Coder (CPC)

Certified Coding Specialist (CCS)

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Epic

eClinicalWorks (ECW)

Google Suite

Job description

This is a full-time, remote position that offers a flexible schedule.

Description:

Physician Coding Auditor is responsible for reviewing and accurately coding all professional multi-specialty services including evaluation and management, diagnostics, surgeries, and procedures in compliance with applicable Medicare, Medicaid, and third-party payer guidelines to ensure receipt of accurate reimbursement. Physician Coding Auditor is expected to adhere to MedKoder’s internal coding/auditing policies and expectations set forth by department management. Physician Coding Auditor must prioritize daily duties, communicate effectively, and make the decisions necessary to complete all assigned tasks and accomplish their goals.

Candidates ideally have recent auditing experience specializing in some of the following profee areas: Ophthalmology, Behavioral Health, Cardiovascular/Cardiothoracic Surgery, Complex ENT Surgery, Dental, Complex Plastic Surgery, Orthopedic Surgery, Peds NICU/PICU, and FQHC/RHC.

Responsibilities:

• Perform professional compliance audits of coding and documentation including surgeries, visits, and other services for multiple provider types across multiple specialties, for multiple clients;
• Accurate application of appropriate coding and documentation guidelines, including ICD-10-CM Guidelines, CPT Coding Guidelines, AHA Coding Clinics, AMA, CMS, Specialty Association/Society guidance, and others, as applicable;
• Accurate selection of CPT codes for services performed;
• Accurate selection and application of modifiers to CPT codes;
• Accurate selection and evaluation of ICD-10-CM diagnosis coding;
• Evaluate the overall quality of physician documentation that supports codes selected including adherence to Medical Necessity;
• Adherence to Local Coverage Determination (LCDs), or National Coverage Determination (NCDs), if applicable; National Correct Coding Initiative (NCCI) edits, and payor-specific policies, if applicable;
• Appropriateness of documentation for split/shared or incident-to services;
• Appropriateness of provider documentation related to Teaching Physician Guidelines, FQHCs, RHCs, and HEDIS, as applicable;
• Accurately score audits utilizing proper scoring methodology;
• Identifies risk areas and provides mitigation strategies and recommendations;
• Provide detailed findings for each service reviewed on customized reports, including supporting documentation;
• Prepare and present audit follow-up education to clients;
• Prepare and present customized education materials based on the unique needs of the client remotely and on-site;
• Communicate with the Physician Audit and Education Manager on issues, trends, and audit timeline task completion;
• Stay current on all coding guidelines (including specialty - specific guidelines), and maintain credentials as necessary;
• Participate in department and education meetings;
• Maintain confidentiality and protect sensitive information;
• Exhibit professional demeanor and communication (written and verbal);
• Other duties as assigned by leadership.

Education/Experience Requirements:

• High School diploma required. Associate or BS degree preferred.
• Successful completion of at least one AHIMA or AAPC certified program with the achievement of the correlating professional credential (CCS, CPC, etc.); active and in good standing. Successful completion of the AAPC CPMA credential is required; preferably a combination of two or more credentials.
• Minimum 5 years of recent physician coding experience and 3 years of recent physician auditing experience are required.
• Must be a subject matter expert on E&M and Surgical coding. Must have expert knowledge of medical terminology, anatomy and physiology, disease processes, CPT coding and guidelines by the AMA, ICD-10-CM coding and guidelines, and Medicare and Medicaid billing policies for professional services.
• Experience working independently, excellent time management, masterful research and organizational skills, the ability to switch between multiple projects, and the ability to meet project deadlines are a must.
• Experience creating and implementing audit plans. Experience educating providers one-on-one or in group settings.
• Additional skills required: Proficiency with Microsoft Word, Excel, PowerPoint, Windows, and healthcare information and billing systems.
• Experience working with Google Suite is preferred but not required.
• Experience working remotely is preferred but not required.
• Epic and eClinicalWorks (ECW) experience is a PLUS.

About MedKoder, LLC:

• Privately held, growing company with strong values and ethics

• Professional development and education

• All positions are permanent – no contracts or sitting on a “coding bench”

• Generous paid time off, holiday pay, and flexible scheduling year-round

• Internal network of Medical Coding Industry Leaders – CEO is a Certified Coder with 20+ years of experience

• Up to 100% EMPLOYER PAID Medical, Dental, and Vision benefits for employees

• 401K and Profit Sharing

• STD, LTD, Life Insurance, and FSA Program

• Paid AAPC and AHIMA corporate memberships

• 30 Hours of CEU pay (continuance in education)

• MedKoder is recognized nationally by Modern Healthcare as Best Place to Work

Are you looking for full-time work (exclusively with MedKoder) that offers full-time benefits?*

We require the following certifications for any auditing position. Are you CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) certified, and CPMA (Certified Professional Medical Auditor) certified through AAPC?*

If you do not have the CPMA credential required for this role, are you willing to get your CPMA within 90 days of hire if you are invited to sign on with MedKoder?*

What other coding certifications do you have other than the CPC/CPMA or CCS/CPMA?*

How many years of Physician Auditing experience do you have?*

Do you currently have E/M Auditing Experience AND Surgical Auditing Experience?*

Select areas of experience:* Anesthesia Behavioral Health/Psychiatry Cardiology Critical Care CT Surgery CV Surgery Dental (D codes) Dermatology E&M (office/clinic and inpatient/observation) Education (providers, individual or group setting) Education (internal team or client facing, individual or group setting) Emergency Dept Endocrinology ENT (Otolaryngology) Family Practice Gastroenterology General Surgery HCC/Risk Adjustment Hospital Medicine Infusion / Injection Internal Medicine Interventional Cardiology Interventional Radiology Neurology Neurosurgery Nephrology NICU PICU OBGYN Oncology Ophthalmology Orthopaedic Pain Management Pathology/Lab Podiatry Pediatrics Plastic Surgery PMR (Physical Medicine & Rehab) Pulmonary Radiation Oncology Radiology Rehab (PT, OT) Rehab (SLP) Trauma Rheumatology Urology Urgent Care Wound Care FQHC/RHC HEDIS Provider Based Billing (PBB) Other (list other areas/specialties not mentioned, or specific specialty surgeries you can audit)

If you checked "Other" on the above question, please add other areas of experience here (and please specify if elaborating on any of the above specialties for EM, Surgical, or both). Otherwise, enter "N/A".*

Please include any additional details that help illustrate your experience in medical auditing, education, and presentations; your specialty skill sets; leadership experience; and any provider- or client-facing roles.*

What Electronic Health Record (EHR) systems and other coding software do you have experience with?*

Are you interested in considering a Lead or Management position in auditing (currently or as a future goal)?*

Tell us what makes you unique and why you would be the best fit. Be creative and say something that will catch our eye!*

Have you ever worked remotely before?*

What is your target hourly rate?*

Have you worked at MedKoder before?*

Have you ever had an interview at MedKoder?* Yes No

Please provide your AAPC or AHIMA Membership ID Number to verify your credentials for the position (please specify which organization).*

If you have a LinkedIn page, please share that link here. Otherwise, enter "N/A".*